Counseling Crime Victims: Practical Strategies f or Mental Health Professionals doc

Acknowledgments xxvii Part I Crime Victimization: Patterns, Reactions, and Clinical Syndromes CHAPTER 1 Crime and Crime Victims: The Clinical and Social Context 3 Types of Criminal V

in Boca Raton, Florida Dr Miller is the police psychologist for the West Palm Beach Police Department and mental health advisor for Troop L of the Florida Highway Patrol He is a forensic psychological examiner for the Palm Beach County Court and a consultant with Palm Beach County Victim Ser-vices Dr Miller serves as an expert witness in civil and criminal cases and is

a consulting psychologist with several regional and national law enforcement agencies, government organizations, and private corporations

Dr Miller is a certifi ed trainer by the International Critical Incident Stress Foundation (ICISF) and a member of the Special Psychology Services Section

of the International Association of Chiefs of Police (IACP), the International Law Enforcement Educators and Trainers Association (ILEETA), the Society for Police and Criminal Psychology (SPCP), the Consortium of Police Psy-chologists (COPPS), the American Academy of Experts in Traumatic Stress (AAETS), and the National Center for Victims of Crime (NCVC)

Dr Miller is an instructor at the Police Academy and Criminal Justice Institute

of Palm Beach Community College and an adjunct professor of psychology at Florida Atlantic University He conducts continuing education programs and training seminars across the country, appears regularly on radio and TV, and is the author of over 200 print and online publications pertaining to the brain, behavior, health, law enforcement, criminal justice, forensic psychology, busi-ness psychology, and psychotherapy He is the author of six previous books,

including the most recent: Practical Police Psychology: Stress Management and Crisis Intervention for Law Enforcement and From Diffi cult to Disturbed: Under- standing and Managing Dysfunctional Employees.

Dr Miller can be reached online at docmilphd@aol.com

Counseling Crime Victims

Practical Strategies f or Mental

Health Professionals

Laurence Miller, PhD

NEW YORK

subject matter covered It is sold with the understanding that neither the author nor the lisher is engaged in rendering a legal, clinical, or other professional service If individual legal, clinical, or other expert assistance is required, the services of a qualifi ed professional should

pub-be sought The material in this book is for educational purposes only and is not intended to provide specifi c clinical or legal advice All instructions for emergency response, crisis inter- vention, and individual clinical strategies should be supplemented by proper training, practice, and supervision

Copyright © 2008 Springer Publishing Company, LLC

All rights reserved

No part of this publication may be reproduced, stored in a retrieval system, or transmitted

in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Springer Publishing Company, LLC

Springer Publishing Company, LLC

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New York, NY 10036

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Acquisitions Editor: Jennifer Perillo

Production Editor: Julia Rosen

Cover design: Joanne E Honigman

Composition: Apex Publishing

Includes bibliographical references and index.

ISBN 978-0-8261-1519-5 (alk paper)

1 Victims of crime—Mental health 2 Victims of crime—Mental health services 3 sis intervention (Mental health services) I Title

[DNLM: 1 Crime Victims—psychology 2 Counseling—methods 3 Psychotherapy— methods 4 Stress Disorders, Post-Traumatic—therapy WM 165 M648c 2008]

RC451.4.V53M53 2008

616.89’14—dc22 2007045882

Printed in the United States of America by Edwards Brothers.

To those who give voice to the voiceless, Names to the nameless, And hope to the hopeless You know who you are, And we remember what you do.

Acknowledgments xxvii

Part I Crime Victimization: Patterns, Reactions,

and Clinical Syndromes

CHAPTER 1 Crime and Crime Victims: The Clinical and

Social Context 3 Types of Criminal Violence and Crime

Real Crime Versus Fear of Crime 10 Risk Factors for Crime Victimization 10 The Psychology of Crime Victimization 11 Crime Victimization: The Therapeutic Mission 12

CHAPTER 2 Psychological Reactions to Crime Victimization:

Posttraumatic Symptoms and Syndromes 13 Posttraumatic Stress Disorder: The Syndrome 13 Acute Stress Disorder 16 Partial and Atypical PTSD Syndromes 16 Child-Specifi c PTSD Symptoms 18

PTSD in Elderly Patients 19 Evolution of the Trauma Response 21 Neuropsychology of PTSD 23 Risk Factors for PTSD 29 Protective Factors for PTSD 31

Traits and Patterns of Resilience to Stress and Trauma 31 The Psychobiology of Mental Toughness 32

CHAPTER 3 Psychological Disorders Associated With

Crime Victimization 35 Anxiety Disorders 35

Schizoid and Schizotypal Personalities 50

Antisocial Personality Disorder 51 Alcohol and Drug Intoxication 53 Traumatic Brain Injury and the Postconcussion

CHAPTER 4 Crime Victim Trauma: Confounding Symptoms

Part II Foundations of Practical and Clinical

Strategies for Crime Victims

CHAPTER 5 On-Scene Crisis Intervention: Guidelines

for Law Enforcement, Emergency Services, and Mental Health Responders 77 Effects of Crime on Victims and Survivors 78 What Crime Victims Say They Need From

First Responders 79 On-Scene Crisis Intervention 81

Validate the Victim’s Reactions 82

Investigate Sensibly and Sensitively 82

Utilize Interpersonal Calming and

Centering 99 Mindfulness 99

Challenging Automatic Thoughts 108

Task-Relevant Instructional Self-Talk (TRIST) 110 Exposure Therapy and Desensitization 114

Numbing, Dissociation, and Self-Harm 118

CHAPTER 7 Counseling and Psychotherapy of Crime Victims 121

General Posttraumatic Therapy Guidelines 121 Phases of Posttraumatic Psychotherapy 122 The Therapeutic Relationship 123 Therapeutic Strategies 125 Therapeutic Techniques 127

Utilizing Cognitive Defenses 130

Specifi c Posttraumatic Issues in Crime Victim Psychotherapy 135

Existential Issues and Therapeutic Closure 138

Existential Trauma Therapy: Beware of False Angels 141

CHAPTER 8 Family Survivors of Homicide: Symptoms,

Syndromes, and Practical Interventions 143 Effect of a Loved One’s Murder on

Family Members 143

Disenfranchised Victims, Disenfranchised Grief 144

Anger, Agitation, Anxiety—and Activism 144

Victim Family Reaction Patterns 147

Grief, Grief Work, and Complicated Bereavement 148

Child-Specifi c Posttraumatic Symptoms and

Children’s Understanding of Death 150

Child-Specifi c PTSD Symptoms 152 Intervention With Family Survivors of

Death Notifi cation and Body Identifi cation 154

Death Notifi cation Do’s and Don’ts 158

Death Notifi cation and Body Identifi cation

CHAPTER 9 Family Survivors of Homicide:

Psychotherapeutic Strategies 163 Family Therapy for Bereavement by Homicide: General Considerations 163 Family Therapy for Bereavement by Homicide: Effective Strategies 165

Emotional Control and Expression 166

Memorialization and Reintegration 168

Psychotherapeutic Strategies 168

Existential-Empowerment Family Therapy 173 What Do Homicide Bereavement Counselors Find Effective? 178 Posttraumatic Therapy of Homicidally

Bereaved Inner-City Youth 180 Self-Help, Support Groups, and

Victim Advocacy 181

Part III Special Victims: Applications of Crime Victim Counseling and Therapy to Populations at Risk

CHAPTER 10 Rape and Sexual Assault 185

Sexual Assault: A Special Kind of Trauma? 185 Psychological Effects of Sexual Assault 186

Telling the Story: Resistances

Psychotherapeutic Strategies for Regaining Control 190

Stress Inoculation Training 191

Exposure Therapy and Desensitization 196

Programmatic Desensitization for Sexual Assault

Risk Factors for Marital Rape 203

Self-Help Efforts of Marital Rape Victims 204

Psychological Interventions for Marital Rape 205

Domestic Violence: Clinical and Demographic

Defi nitions of Domestic Violence 211 Factors Contributing to Domestic Violence 211

Personality and Psychopathology 211

Socioeconomic and Cultural Infl uences 212

Illness, Disability, and Pregnancy 213

Law Enforcement Response to Domestic

Police Response to Domestic Calls:

Citizen Dissatisfaction With Police

Law Enforcement Domestic Calls:

Law Enforcement Domestic Calls:

Law Enforcement Domestic Calls: Mediation

Psychotherapy and Counseling of Domestic Violence Victims 221

Crisis Prevention and Intervention 222

Domestic Violence in Police Families 223

Police Offi cer Domestic Violence: Facts and Stats 224

Police Offi cer Domestic Violence Intervention:

Investigation and Response to Incidents 226 Domestic Violence in the Workplace 227

Domestic Violence at Work: Facts and Stats 227

Recognizing the Warning Signs 228

Workplace Violence: Facts and Stats 234 The Workplace Violence Cycle 236 Workplace Violence Prevention 237

Prevention of and Protection From

Defusing a Potentially Dangerous Situation 239

Workplace Violence Recovery 244

Plans, Policies, and Procedures 244

Restoring Order: Posttrauma Crisis Management 246 Role of Executives and Leaders 247 Workplace Violence: Psychological Effects 247

Workplace Violence Response Patterns and Syndromes 247 Posttraumatic Stress Disorder in

Assaulted Staff Action Program (ASAP) 256

Enhanced Debriefi ng Model (EDM) 257

CHAPTER 13 Bullying and School Violence 259

Peer Victimization: Terms and Defi nitions 259 Peer Victimization and Bullying: The Legal

Types of School Bullying and Harassment 260 Types of Bullies 261 Types of Victims 262 Types of Bystanders and Witnesses 263 Bullying: Causes, Risk Factors, and Protective

Effects of Bullying 265 School Programs for Management of Bullying: The P.A.S.S Model 265 Student Strategies for Handling School

Bullying: The D.I.C.E Model 266

Handling a Bullying Encounter:

What Kids Can Do 267 Handling a Bullying Episode:

What Adults Can Do 269 Psychotherapy and Counseling With

Victims of Bullying 271 School Violence 274 Demographics and Clinical Effects of

School Violence 274 School Violence Perpetrators 275 Preventing School Violence 276

Safe Suspension or Expulsion 277 Responding to School Violence 277

Warning Signs of Impending Violence 277

Policies and Procedures for School

Preventing a Potentially Violent Episode 278

Managing a Potentially Violent Situation 279

Recovering From School Violence 281

Law Enforcement, Physical Security,

Student and Family Interventions 281

Legal Issues and Postincident Investigations 282 Psychological Interventions for School

Violence Victims 282

The Nature and Purposes of Terrorism 287 Psychological Reactions to Terrorist Attacks 288

Terror: The Ultimate Traumatic Event? 288

Toxic, Radiological, and Biological Terrorism 290

Psychological Responses to Mass Terror Attacks 291

Characteristics of Disasters 292

The Disaster Response: Clinical Features 293

Phases of the Disaster Response 294

Individual Responses to Disasters 295 Psychological Interventions for

Terrorist Crises 296

On-Scene Mass Casualty Intervention 300

Death Notifi cation and Body Identifi cation 301

Short-Term Crisis Intervention Protocols 302

Critical Incident Stress Debriefi ng (CISD) 302

NOVA Model of Group Crisis Intervention 302

Psychological Intervention With Children and Families After Mass Casualty Terrorism 304

Individual and Group Treatment Modalities for Children Following Terrorist Attacks 305 Community and Societal Responses to

Terroristic Trauma 307

National and International Responses 309

CHAPTER 15 Our Own Medicine: Counseling and

Psychotherapy of Mental Health Professionals 311

Stresses and Challenges of Crime Victim

Effects of Crime Victim Work on Clinicians 314

Transference, Countertransference, and

Psychological Interventions With Counselors and Therapists 317

Psychological Debriefi ng: Debriefi ng the Debriefers 318

Psychotherapy With Crime Victim Counselors and Trauma Therapists 322

General Decompression and Self-Help Measures 322

Therapeutic Support for Traumatized Therapists 323 Psychotherapy With Traumatized Therapists 324

CHAPTER 16 Your Day in Court: Crime Victims, Mental

Health Clinicians, and the Legal System 329

Crime Victim Stresses in the Criminal Justice System 329

Experiences With the Criminal Justice System 333

Specifi c Risks and Benefi ts of Participation

Forensic Psychological Evaluation of

Nature and Purposes of a Forensic Psychological Evaluation 336 Forensic Versus Clinical Psychological

Evaluations 336 Role of Victim Counselors in the

Types of Witnesses and Testimony 340

Victim Support Services and the Criminal Justice System 347 Civil Litigation for Crime Victims 349

Crime, Torts, and Psychological Injury 350

Torts, Negligence, and Damages 350

Causation and Responsibility 351

Diagnosis of PTSD in the Litigation Setting 353

Clinicians, Lawyers, Patients, and

Victims of crime, particularly violent crime, face some unique challenges They are thrust into a universe most never could have anticipated Their formerly trusting perspective on human goodness surely will be threatened Their assumptions of justice and the legal system can be contested in ways that defy how they can order their personal world

If victims are fortunate enough to recover from physical injuries, many cover that the emotional impact cuts deeper than they would have suspected That can further complicate their recovery as they second-guess whether they are “normal” after all

Those who are committed to supporting victims in the aftermath of their emotional trauma discover that learning a whole new language and culture is

a necessity for providing meaningful assistance

Dr Miller’s work is a practical primer on the recognized language and ture of crime victimization, particularly at the emotional and psychological level While intended specifi cally for mental health professionals, this book is a valuable reference for all who serve victims in any direct capacity He provides

cul-a sensible cul-and functioncul-al brecul-adth cul-and depth of knowledge thcul-at exposes the extraordinary dimensions associated with victim response and intervention Those who have fi eld experience will immediately recognize the functional nature of Dr Miller’s labor while certainly discovering new insights for serving victims of all kinds

Will Marling, MDiv, DMin, CCR Interim Executive DirectorThe National Organization for Victim Assistance

January 2008

He didn’t just attack my body; he stole my soul

—Sexual assault victim, 1997

More than an accidental injury, more than a serious illness, more than a natural disaster, the trauma of crime victimization goes beyond physical and psychological injury: It robs us of the very faith we have in the human world Although eclipsed in recent headlines by terrorism, the common everyday violations of civilized behavior that our own citizens continue to perpetrate

on one another are no less wrenching

As more and more mental health professionals are becoming involved in the criminal justice system—as social service providers, victim advocates, court liaisons, expert witnesses, and clinical therapists—there has not been a commensurate improvement in the quality of teaching material to address this expanding and diverse fi eld Until now, students and practicing professionals have had to content themselves with either overly broad texts on criminology

or trauma theory, or with narrow tracts on one or another subarea of victim services

Counseling Crime Victims: Practical Strategies for Mental Health Professionals

provides a unique approach to helping victims of crime By distilling and combining the best insights and lessons from the fi elds of criminology, victim-ology, trauma psychology, law enforcement, and psychotherapy, this book presents an integrated model of intervention for students, trainees, and work-ing mental health practitioners in the criminal justice arena In this volume, I’ve tried to creatively integrate solid empirical research scholarship with practical, hit-the-ground-running recommendations that mental health pro-fessionals can begin using immediately in their daily work with victims This includes direct advice to impart to victims and their families on how to stay alive during a crime in progress and on how to cope with police, clinicians, lawyers, judges, and social service agencies

As in any solidly grounded but user-friendly volume, this book is part scholarly review, part practical clinical wisdom, and part personal journey My own work with crime victims has converged from two directions The fi rst is the fi eld of neuropsychology and traumatic brain injury and other traumatic disability syndromes, such as chronic pain and posttraumatic stress disorder Many of these patients have been involved in motor vehicle or workplace accidents, but a fair number are injured in the course of a criminal assault

My work with physical and psychological trauma patients led to an interest

in traumatic stress syndromes in law enforcement and emergency services personnel, and I soon found myself clinical director of the Palm Beach County Critical Incident Stress Management Team serving the county’s police offi -cers, fi refi ghters, and paramedics This in turn led to my close and fruitful involvement with the West Palm Beach Police Department and other local and regional law enforcement agencies

Around the same time, my practice in forensic psychology had been focused largely on civil cases involving workers’ compensation and personal injury but, as I became more involved with law enforcement and the criminal justice system, I began to see more and more criminal cases, both from the perspec-tive of evaluating suspects for competency to stand trial and insanity defenses and evaluating victims for symptoms of stress and psychological disability In addition to evaluations, many of these crime victim cases were referred to me for treatment Thus, I’ve had the professional opportunity to experience the forensic psychological aspects of crime and crime victimization from the clini-cal psychology, law enforcement, and criminal justice perspectives

For this book’s title, the term counseling is not chosen lightly and, as used

throughout this book, has a number of important overlapping meanings and implications for treatment To begin with, counseling encompasses all the phases and components of helping crime victims: psychological, legal, social service, philosophical, and spiritual; counseling is not just limited to weekly clinical sessions An especially important dimension of counseling is its proac-

tive nature: As I’ve emphasized elsewhere, the best form of crisis intervention is crisis prevention, and the best way to help a crime victim is to keep him or her

from becoming one in the fi rst place Thus, this book places great emphasis

on what might be called preventive mental health, by analogy to preventive

medicine Many of the strategies you’ll learn in the following pages can be used by your patients (and yourself) to keep them (and you) from being a victim, or in the case of a crime already committed, the strategies in this book can help mitigate the harm done

But bad things do happen to some good, bad, or in-between people and counseling also incorporates a number of postcrime interventions for vic-tims Here again, the purview of counseling is broad and encompasses crisis

intervention literally within minutes of the traumatic victimization, to term psychological stabilization, to later therapeutic processing, to long-term clinical follow-up and guidance through the civil or criminal justice system

short-To counsel your patient, then, is to directly aid him or her in the deepest,

broadest way you can and help the patient secure the additional services that can assist further

While we’re discussing semantics: The term victim is used purely

descrip-tively in this book, to refer to someone who has had a criminal act trated on him or her It is not intended to be understood as any kind of a

perpe-value judgment, as in the sometimes pejorative term victim mentality Another

semantic point refers to crime victims under clinical care who I here refer to

as patients, simply because this is the terminology I was trained in and feel

most comfortable with Some clinicians are more comfortable with the term

clients, in which case feel free to make that mental substitution while reading these pages As an interesting linguistic aside, the term patient derives from the Latin, “one who appeals for help,” whereas the derivation of client is “one

who depends.” Psychotherapists know that words and their meanings carry great weight in our interactions with patients Thus, we must ensure that we communicate clearly and supportively to those we are trying to help

The case examples chosen for this book are snippets of either actual cases (disguised for confi dentiality) or composites of cases, and you will notice that many of them involve criminal victimizations that are not excessively grue-some or horrifi c That’s because, in routine outpatient clinical mental health practice, you’re more likely to see larger numbers of noncatastrophic trau-

matic injuries and, consistent with the principle that everybody’s pain is real

to them, it is essential to have the clinical and empathic skills to work

pro-ductively with these crime victims, just as it is essential for the clinician who works in a hospital or other inpatient setting to have the skills to work with more severely injured patients The principles in this book will apply to crime victims at all levels of injury and traumatization

Although each chapter can be read on its own merits, this book is nized sequentially Part 1 provides a solid clinical and empirical background

orga-on types of crime, victimizatiorga-on patterns, and commorga-on and unusual logical reactions to crime victim trauma I spend a good deal of time delin-eating various symptoms and syndromes because this richness of clinical presentation is what you’ll see in real-life practice and the fi rst step to effective treatment is always proper diagnosis and case formulation

psycho-The chapters in part 2 cover each stage of intervention involving a crime scenario, from preventing crimes from occurring or escalating, to immediate law enforcement and emergency mental health response to the crime scene itself, to short-term symptom management, to ongoing psychotherapy This

includes strategies for working with direct victims of crime as well as family members of deceased crime victims, including children.

Part 3 applies the lessons learned in the previous chapters to addressing the unique needs of what might be called the “special victims” that you may encounter in your work: victims of sexual assault, domestic battery, workplace and school violence, and—in this new and strange age—victims of terrorism

A special chapter is devoted to the care and maintenance of mental health professionals—that’s you and me, folks—who do this kind of intense, gritty, demanding clinical work Strategies are offered for beating burnout, staying sharp, and coping with the costs of caring And if you work with crime vic-tims, it’s inevitable that you’ll at some point become involved in the civil and/or criminal justice system; accordingly, the fi nal chapter provides both you and your patients with a practical guide to forensic evaluations, court-room testimony, and working with attorneys, victims rights groups, and social service agencies

I’m counting on the fact that Counseling Crime Victims: Practical Strategies for Mental Health Professionals will not be the kind of book that readers fl ip

through once and consign to bookshelf purgatory I intend this volume to

be the kind of dog-eared, Post-It–covered, underlined, yellow-highlighted, and margin-scribbled practical guide and reference book that working mental health clinicians consult again and again in their daily practices This book will also be of use to attorneys, judges, law enforcement offi cers, social service providers, and other professionals who work with crime victims in a variety

of settings The book can also serve as a text for courses in clinical psychology, forensic psychology, criminology, and criminal justice

Finally, only you will know if this book has accomplished its therapeutic

mission, and the only way I’ll know is if you tell me Therefore I invite readers

to contact me with any comments, questions, critiques, or recommendations for future editions of this volume Look, you don’t need me to teach you how

to do psychotherapy; you’re already good clinicians, and the fact that you’re even holding this thick tome in your hands proves your dedication to enhanc-

ing and honing your professional skills What this book will do is help you

expand and apply those skills to the special needs of victims who have been assaulted in body, mind, and spirit so that you can guide these souls back into the human community they have been cast out of So start reading, get to work, and let me know what you’ve accomplished

Laurence Miller, PhD October, 2007

a most appropriate outlet for this work at Springer Publishing Company

Special thanks goes to International Journal of Emergency Mental Health editor

Dr Richard Levenson for his continued support of my published work in traumatology, victimology, criminology, and law enforcement psychology over the years Rich also introduced me to Springer Publishing acquisitions editor Jennifer Perillo, who believed in this project and displayed Jobian patience

while waiting for the manuscript to be completed (aw, c’mon, it wasn’t that

late) and then, along with project manager Julia Rosen, she helped refi ne the manuscript’s essential message, with a collectively deft yet restrained redac-tive hand, into the practical guidebook you now hold

I had always considered it a kind of cornball conceit for clinical authors

to thank their patients (if you were so grateful, doc, did you cancel your bill?), and I’ve always viewed such acknowledgments skeptically—until it was my turn My clinical patients and organizational consulting clients con-tinue to reinforce the importance of seeing people—as both individuals and

as groups—beyond the diagnostic labels and problem descriptions that often propel them into my offi ce So yes, they’re grateful to me for helping them, and I’m grateful to them for teaching me how to help others It’s so corny, it’s actually true

Other important lessons have been learned from the mental health cians, social service workers, victim advocates, support group members, and law enforcement offi cers I’ve worked with over the years While I’d like to say that all of these professionals do their jobs out of selfl ess devotion to the

clini-welfare of others, let’s face it, for some it’s just a day’s work But how they do

that day’s work is what’s important, and I continue to be impressed by the way these individuals use their instincts, training, and common sense to do the kind of work that often necessitates making the impossible routine.Last, but never least, my family once again earns my gratitude for endur-ing the prolonged absence of yet another self-imposed exile while completing this book For better or worse, living with an author who often does his writ-ing after coming home from his day job, they’ve learned to get used to brief glimpses of me when I pop my head out for air But I hope they understand that I never stop appreciating their support for the work that I do

P A RT I

Crime Victimization

Patterns, Reactions, and Clinical Syndromes

Crime and Crime Victims

The Clinical and Social Context

Certain traumas do more than injure us; they violate our sense of security and stability, yank the existential ground right out from under our feet More than most traumas—illness, technological accidents, natural disasters—violence deliberately and maliciously perpetrated by other people robs us of our sense that the world can ever be a safe place again The suddenness, randomness, and fundamental unfairness of such attacks can overwhelm victims with help-lessness and despair As diffi cult as it may be to bear the traumas of injury and loss that occur in accidents and mishaps, far more wrenching are the wounds that occur at the deliberate hands of our fellow human beings, that result from the callous and malicious depredations of others Assaults, rapes, robberies, and even petty but frightening harassments and threats can all nick, dent, and occasionally pierce the psychic shell of security we all envelop ourselves in to get through the day Violent crimes shatter us in mind, body, and soul

In some populations, as many as 40% to 70% of individuals have been posed to crime-related traumas suffi cient to meet diagnostic criteria for post-traumatic stress disorder (PTSD) and other syndromes (chapters 2, 3, 4), and many individuals have endured multiple exposures to such extreme stressors (Breslau & Davis, 1992; Breslau, Davis, Andreski, & Peterson, 1991; Breslau et al., 1998; Davis & Breslau, 1994; Norris, 1992; Resnick, Acierno, & Kilpatrick, 1997; Resnick, Kilpatrick, Dansky, Saunders, & Best, 1993; Scarpa et al., 2002) Except for rape, men appear to be assaulted under the same kinds of situations

ex-as women, but it may be more diffi cult for a man to report any kind of ex-sault for fear of shame, ridicule, or disbelief (Saunders, Kilpatrick, Resnick, & Tidwell, 1989)

TYPES OF CRIMINAL VIOLENCE AND CRIME

in this age of terrorism (chapter 14), for many Americans today, local violent

crime is the overriding social and political issue The bad guys seem to have

gotten more brazen, while the rest of us cower helplessly, feeling victimized not just by the criminals but by the justice system that is supposed to protect

us (Bidinotto, 1996; Kirwin, 1997)

“Give it up, bitch.” That was the fi rst and last thing Janet heard before she hit the ground Just seconds before, she’d been walk-ing to her car in the parking lot of a shopping mall at dusk Laden with packages, she didn’t see the tall fi gure in the green hooded sweatshirt until too late The assailant pushed her to the ground and warned her not to look up or he’d shoot her dead Rifl ing through her belongings, he apparently wasn’t satisfi ed with the yield and, out of frustration or sheer meanness, he put his foot on the prostrate woman’s cheek and proceeded to grind her face into the pavement for several seconds, telling her over and over again that she would be killed Then, something must have startled him because, as quickly

as he appeared, he abruptly fl ed Mall security and the local police soon arrived, but the assailant was never apprehended

“My whole life is ruined,” Janet later told her counselor Several months after the attack, she could still not go to shopping malls, and seeing dark green clothing of any type produced terrifying fl ash-backs of the assault Although she sustained only minor lacerations and abrasions on her cheek, she suffered bouts of excruciating facial pain She was worked up neurologically for trigeminal neuralgia, but all the standard medical tests were negative Sleep was almost impossible due to nightmares of being chased and attacked by “wild

animals.” Sometimes at night she could hear the phrase “Give it

up, bitch” playing repeatedly in her head, which she described as being “like a stuck tape loop.” She got frequent headaches and night sweats and had lost more than 30 pounds Her doctor prescribed tranquilizers and told her to “get some help.”

Criminal assault can be all the more psychologically destabilizing when

it occurs on home ground, at home or work where we are supposed to feel safe

His friends and family told him not to take his fi rst Phys Ed teaching job in such a rough high school, but Mark had always prided him-self on being a mediator and peacemaker Besides, as a former high school and college football player and wrestling team member, he was hardly a wuss and could cut quite an imposing presence when

he needed to show authority So he didn’t think it would be that big

a deal to break up a fi ght during a recess basketball game—until one of the combatants pulled a shank and stabbed him for his ef-forts He recalls the emergency room doctors telling him his wound was potentially life-threatening and “I remember thinking, ‘how’s

that different from really life-threatening?’ But at no time did I really

think I was going to die I fi gured I’d just take a few weeks off, get over this, and go back to work.”

And, being young, healthy, and enthusiastic, he recovered from his physical injuries But even during his convalescence, he began notic-ing problems Ball games on TV, which he used to love, now disturbed him, giving him “an itchy kind of nervousness” when he watched them On his fi rst day back at the high school, he was stunned to re-alize that he couldn’t bring himself to walk onto the basketball court

“It was like that force fi eld on the starship Enterprise—I just couldn’t get past it I’d get all dizzy and have to turn back.” Embarrassed and dismayed, he took a semester’s leave of absence and, as of last con-tact, hadn’t yet returned to teaching

One of the realities of doing crime victim work is the realization that petrators and victims do not come in neat, separate, diametrically opposed packages Some victims are targeted through no fault of their own, yet may lead questionable or marginal lifestyles that all too often put them in the wrong place at the wrong time

“Hey, I’m no angel,” Manny allowed “I like to party as much as the next guy So maybe me and my crew were getting a little wild at the

bar, but, hey, you’re supposed to go there to have fun, right? All of a sudden, this bouncer is telling us to cool it or we’d have to leave Hey, between the drinks and the girls, I already dropped a small fortune

on that place, so I ain’t going nowhere, see? Okay, maybe I had an attitude and used a few choice words, but I sure didn’t start a fi ght Next thing I know, I’m being bum-rushed out the door, so I kind of pushed back, you know? Then, there must be four, fi ve guys on me, kicking and punching At one point, I could hear my head crack and

I thought I was gonna pass out Then, I’m lying there on the sidewalk and my friends come out of the bar looking for me I wanted to go back in, but they talked me out of it So we went to some other place, but I don’t have a very good memory for the rest of that night

“I fi gured that was that, but then for the next couple of days, I was feeling kind of tired and foggy and I was forgetting things, so I went

to see a doctor who said it sounded like I had a concussion and told

me to ‘take it easy’—yeah, like that’s gonna happen Those fuzzy feelings passed after about a week or so, but then I noticed that going out with the guys at night wasn’t as much fun anymore I’d sit

in a bar or club and just kind of get bored or antsy, like I wanted to

be somewhere else, so we’d go to a new place, but then I’d want to get out of there, too I was starting to feel like a real drag and even

my friends said I wasn’t much fun anymore

“And, this is the weird part that I haven’t told too many people, but a few times I’d be sitting in a bar and I could swear I could see or feel a bunch of guys closing in on me like they were gonna attack me—but there was nobody there! That’s when I thought I was really starting

to go nuts And then, a couple of times a week, I’d be like half asleep, not a dream or anything, just like dozing off on the bus or while I was watching TV in bed or something, and I’d feel a crack on my head, like I got hit with a bat, and I’d bolt right up and feel my head, but there was nothing there I went back to the doc who saw me for my concussion and he said to see somebody like you, so here I am.”

A number of diagnosable psychiatric syndromes may be seen following criminal assault Depression, anxiety, PTSD, and substance abuse are common psychological disorders (chapters 2, 3, 4) found in victims of robbery, rape, and burglary (Falsetti & Resnick, 1995; Frank & Stewart, 1984; Hough, 1985), and a high proportion of panic attacks trace their onset to some traumatically stressful experience (Uhde et al., 1985) In a follow-up study, approximately 50% of crime-induced PTSD cases were found to persist in a chronic course after 3 months (Rothbaum, Foa, Riggs, Murdock, & Walsh, 1992) Clinical

experience suggests that such traumatic effects may persist in some form for far longer—years, decades, or a lifetime

A criminal act can affect those not directly assaulted or killed When a family member has been murdered, surviving family members may be plagued by intrusive images of what they imagine the scene of their loved one’s death to have been, even if—perhaps especially if—they were not present at the time

of the death (Falsetti & Resnick, 1995; Schlosser, 1997) Criminal assault vivors may be scapegoated and blamed for their attack by friends and family members seeking to distance themselves from the contagious taint of vulner-ability that crime victims are all too often imbued with (chapters 2, 10)

Abduction and Torture

Perhaps the most extreme form of violence that one human being can trate on another is abduction and torture These acts typically take place

perpe-in a military or political context, such as an act of terrorism, or as part of a civil crime such as a botched robbery, attempted extortion, sadistic sex crime, domestic dispute, or revenge Treatment of captives can range from gracious

to atrocious and may sometimes vary between these two extremes within the same event The duration of captivity may range from minutes to years, but in most civilian crime settings, kidnappings or hostage crises where the victims survive are typically resolved within hours or days (Frederick, 1994; Mollica, 2004; Rosenberg, 1997; Miller, 2002c, 2005c, 2007h)

Stefan, a middle-aged businessman, was abducted from the ground parking garage of his offi ce building by criminals who mis-took him for an errant gang member who’d skipped with a large sum of their money He was thrown into the back of a van and taken

under-to a remote motel room where he was beaten and under-tortured for eral days before fi nally being dumped unconscious onto a deserted street where he was found and taken to a local hospital He claimed

sev-to have virtually no memory of the ordeal itself, aside from a few frightening dream-like images In addition, his overall short-term memory and concentration were seriously impaired

One of the differential diagnostic dilemmas in this case was fi ing out how much of Stefan’s well-documented cognitive impairment was due to head trauma sustained in the beatings and how much

gur-to extreme psychological numbing associated with PTSD (chapter 2) Happily, this man was able to obtain a degree of justice in seeing his attackers prosecuted, which aided greatly in his integrating the trauma and getting on with his life (chapter 16) However, he will always

carry a certain edgy wariness about him, and he now tries never to go anywhere alone Underground parking is out of the question

It is hardly surprising that kidnapping, with or without actual physical olence, can produce severe posttraumatic stress reactions Yet many captives manage to survive their ordeals relatively intact, some even emerging somewhat seasoned and ennobled by their experience Several factors seem to be associated with better outcomes after hostage situations (Frederick, 1994; McMains & Mullins, 1996; Miller, 1998h, 2002c, in press-c; see also chapter 14):

vi-• Age over 40

• A belief in one’s own inner strength of self

• Refl ective thoughts of loved ones

• Faith in a higher power

• Continuing the hope that the captivity will end favorably

• Using one’s powers of reasoning and planning to fi gure out possible plans for escape or release

• Physical or mental exercise

• Appropriate expression of anger, where safe and feasible

• Ability to focus attention and become task-oriented

Psychological preparedness may promote a sense of control over the trauma (Hoge, Austin, & Pollack, 2007) In a study examining psychopathology in victims of torture, those who were political activists appeared to show more resilience These individuals were thought to be relatively insulated psychologi-cally by their commitment to a cause, training in stoicism, and prior knowl-edge about torture techniques (Basoglu et al., 1997) Other researchers have also found that prior training in emergency work appears to enhance resilience (Alvarez & Hunt, 2005; Hagh-Shenas, Goodarzi, Dehbozorgi, & Farashbandi, 2005; Miller, 1989b, 2005d, 2006m, 2007m; Regehr & Bober, 2004)

Crime in the Community

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR;

Ameri-can Psychiatric Association [APA], 2000) recognizes that posttraumatic stress reactions can occur in persons who observe terrible events happening to oth-ers, even if they are not directly, physically affected This includes witnessing crimes of violence or threats of violence against others Indeed, certain seg-ments of the population may be exposed to traumatically stressful events on a fairly regular basis, for example, residents of crime-ridden and socioeconomi-cally depressed inner-city neighborhoods

Breslau and Davis (1992) and Breslau et al (1991) studied over one sand young adults from a large health maintenance organization in inner-city Detroit and found that many of these residents showed classic signs and symp-toms of PTSD Precipitating events included the standard traumatic events of sudden injuries, serious accidents, physical assaults, and rape But also im-portant was the traumatic effect of having one’s life threatened without actu-ally being physically hurt, getting news of the death or injury of a close friend

thou-or relative, narrowly escaping injury in an assault thou-or accident, thou-or having one’s home destroyed in a fi re Overall, almost half of this sample of young, inner-city adults reported experiencing potentially traumatic events and about a quarter

of them developed full-blown PTSD

Many of the young adults with PTSD continued to experience symptoms for a year or longer These chronic PTSD sufferers were more likely than those whose symptoms resolved sooner to show hyperreactivity to stimuli that sym-bolized the traumatic event, as well as interpersonal numbing (chapter 2) They were also more likely to report greater anxiety, depression, poor concen-tration, and medical complaints Women were found to be more susceptible

to PTSD than men, and subjects were more likely to experience traumatically stressful events if they were poorly educated, more outgoing, and impulsive;

if they had a history of early conduct problems; or if they came from families with psychiatric and substance abuse histories This makes sense: As noted above, people who are more impulsive and disturbed to begin with tend to take greater risks and more often fi nd themselves in trouble-prone situations where they may be victimized and traumatized Thus, in many cases, criminal activity may be as much related to the impulsivity and maladaptive lifestyle that leads to traumatic events in the fi rst place as it is to the stress syndromes that result from those events; a similar relationship has been noted for im-pulsive antisociality, aggressive behavior, and traumatic brain injury (Miller,

1987, 1988, 1993e, 1994c, 1998d, 2001d, in press-d)

More recently, Breslau et al (1998) surveyed over two thousand adults

in the Detroit area, aged 18 to 45, to assess the lifetime history of traumatic events and PTSD They found that almost 90% of the sample had been ex-posed to one or more traumatic events over their lifetime The most prevalent type of trauma was the sudden, unexpected death of a close relative or friend Men, non-White minorities, and economically poorer persons were more likely

to be exposed to criminal assault, and assaultive violence carried the highest risk for PTSD, compared to any other kind of trauma Another class of trauma with high PTSD rates was sudden unexplained death of a loved one A little less than 10% of men exposed to traumatic events developed PTSD, and this rate was doubled for women In most cases, PTSD persisted for more than 6 months, and the duration was generally longer for women

More recent studies have demonstrated that young people as a group are

at a disproportionately high risk of exposure to violence (see also chapter 13), with up to 80% of young adults reporting having been a victim of violence, and over 90% reporting being a witness to violence (Scarpa, 2001; Scarpa

et al., 2002) Furthermore, this appears to produce a vicious cycle—the called cycle of violence—with those victimized showing more aggression themselves Those most likely to turn their victimization into aggression ap-pear to be characterized by high rates of victimization, avoidant and emotion-focused coping styles, and low perceived support from friends and others (Garbarino, 1997; Scarpa & Haden, 2006)

Real Crime Versus Fear of Crime

Now, some more bad news: Fear of crime may be hazardous to your health Increasingly, social scientists are fi nding that the sheer overload of crime and disaster stories in the media, especially on local television newscasts, is giving the public a warped view of reality and contributing to a type of media- induced

trauma known as mean world syndrome (Budiansky et al., 1996) Because most

of the general public have little direct experience with crime, our beliefs about crime and the criminal justice system are largely based on what we see on TV and read in the newspapers, where sensational and violent crimes are often overrepresented This may have the paradoxical effect of oversensitizing people

to nonexistent or insignifi cant threats, while at the same time numbing the lic’s understanding of the true impact of crime victimization when it does occur (Miller, 1995a, Miller & Dion, 2000; Miller, Agresti, & D’Eusanio, 1999) Political scientist Robert Putnam of Harvard University has observed that the rise of television in the 1950s led to a “civic disengagement” of Americans around 1960 Television watching may breed pessimism and apathy The mean world syndrome makes us paranoid about our neighbors and cynical about society and human nature in general (Budiansky et al., 1996) Just as importantly, if falsely exaggerating the extent of the crime problem contributes

pub-to a deterioration of mental health in individuals or groups, are news services liable for damages by engaging in what would amount to journalistic malprac-tice? Stay tuned

RISK FACTORS FOR CRIME VICTIMIZATION

In general, women are more likely to be victims of sexual assault, often by people they know, such as husbands, ex-husbands, boyfriends, or relatives (chapter 10), while men are more likely to be physically assaulted by strangers The risk of

sexual assault diminishes with age, while risk of physical assault increases with age earlier in life but then declines as men get older Having been victimized in the past appears to be a risk factor for future victimization, probably because most people cannot easily escape the sociodemographic factors that put them at risk Women are likely to develop PTSD at about the same rate following both physical and sexual assault, while the rate of PTSD for men is lower for physi-cal assault but very high for sexual assault, which for men is a rarer and more humiliating event than physical assault (Kilpatrick & Acierno, 2003)

THE PSYCHOLOGY OF CRIME VICTIMIZATION

Russell and Beigel (1990) conceive of crime victimization as comprising eral layers in relation to a person’s core self:

• Property crime like burglary generally hurts victims only at the

out-ermost self-layer (i.e., their belongings), although the theft of certain meaning-laden family heirlooms can have a much greater emotional impact

• Armed robbery, which involves personal contact with the criminal and

threat to the physical self of the victim, invades a deeper cal layer

psychologi-• Assault and battery penetrates still deeper, injuring the victim both

physically and psychologically

• Rape goes to the very core of the self; perverts the sense of safety and

intimacy that sexual contact is supposed to have; and affects the tim’s basic beliefs, values, emotions, and sense of safety in the world Society’s response to crime also plays a role in how supported or aban-doned victims feel (Russell & Beigel, 1990) For example, when a child comes home from school and tells his parents that the teacher was mean and made him sit in the corner, a common parental response is to inquire, “What did you do to make the teacher punish you?” From experiences such as this, many people grow up thinking that if something bad happens to them, they some-how deserved it Also, taking the blame for something, even if you logically know it’s not your own fault, is often a more existentially reassuring stance than having to believe that something this terrible can just happen for no reason— because, if there’s nothing you did to contribute to it, then there’s nothing you can do that will prevent it from happening again, or something even worse happening, any time, anywhere (Miller, 1994b, 1996a, 1998e, 1998h, 1999d, 1999i, 2001d)